Steven D. Jackson
Student, American Military University
Erythropoietin (EPO) use as a performance enhancing agent in sport carries both significant and detrimental risks to go along with its suggested benefits. As such, it was banned by the International Olympic Committee in 1990. Shortly thereafter, successful and reliable testing methods have been developed to test athletes for its potential use. Despite widespread knowledge of its potential adverse effects and the testing for its attempted use, EPO use remains substantial amongst endurance athletes of nearly all ages and disciplines, both professional and amateur. This paper will provide a history of EPO as a performance enhancing substance, explain its associated risks and perceived and actual benefits, attempt to analyze why athletes feel compelled to use it, and examine the sanctions, regulations, and weighty repercussions associated with its use.
Erythropoietin and Athletes
In sport, there are a virtually limitless number of ways in which one can influence or positively impact physical or mental performance. These methods can come in the form of mechanical aids, pharmacological aids, physiological aids, nutritional aids, and psychological aids. Regardless of its source, any means by which one seeks to improve performance by enhancing the physiological capacity of a particular system of the body, removing psychological constraints which adversely affect performance, or by accelerating recovery from training or competition is called an ergogenic aid (MacKenzie, 2001). These may include something as simple and innocuous as a healthy meal consumed the night prior to a competition, but seemingly, the ergogenic aids which athletes are turning to more increasingly are those that have been banned by organizations such as the World Anti-Doping Agency, the International Olympic Committee, and the like. Often, these substances have been banned because they not only represent perverse and unethical behavior, but also, as is the case for a substance like recombinant erythropoietin, because they can have serious adverse health effects for their users. Over time, these substances have changed, but the desire to gain an unfair competitive advantage remains.
Hematopoiesis is the process which involves the production of mature cells in the blood and in lymphoid organs. Mature erythrocytes, or red blood cells, have no nucleus, so they cannot reproduce in the traditional fashion as other cells can. Erythropoiesis, then, is the process by which erythrocytes are produced. Erythropoietin is a naturally occurring hormone found within the human body which controls this red blood cell production. It is released by the kidneys, and to a lesser extent the liver, and in very little quantities in the brain in response to a negative feedback. The physiological stimulus of erythropoietin production is hypoxia, or prolonged oxygen deficiency in body tissue, and in the majority of instances is related to the number of circulating erythrocytes within the kidneys. At high altitudes, for example, where the pressure oxygen in the air is reduced, oxygen delivery to the body’s tissues initially decreases. This drop in oxygen triggers the release of erythropoietin, which travels via the blood to the red bone marrow and stimulates red blood cell production (Shier, Butler, & Lewis, 2011). This is important to note, as this negative feedback of loss in oxygen is essentially no different than the body observing a loss in blood, which also necessitates the release of erythropoietin. In cases of hemolysis or hemorrhage, erythrocyte production will also increase rapidly and substantially for the body to attempt to accommodate for the amount of blood lost. However, overproduction of erythrocytes does not occur, both in extreme hypoxic environments and even after the most severe loss of erythrocytes (Robinson, et al., 2006). This balance is...